NYAPRS Note: From last Friday's Politico piece by What's next for Medicaid Waivers' by Rachana Pradhan and Brianna Ehley.
MEDICAID WAIVERS:
Republicans are likely to use waivers to enact changes the Obama administration has rejected, in particular for non-disabled adult populations.
That includes letting states impose work requirements for Medicaid beneficiaries, larger penalties for not paying required premiums and copays, greater leniency on benefit packages and limits on how long people can stay on the program. Greater use of Medicaid managed care is also likely to be a focus.
"Give flexibility. We've asked for waivers ad nauseam and it takes us a year to be turned down," Utah Gov. Gary Herbert said Thursday in Washington, after he and several other Republican governors met with Senate Finance Committee Republicans about overhauling Medicaid.
If Trump's team at CMS wants to send an early signal, some states already have waiver proposals pending with the feds. They include an ACA expansion plan from Kentucky - which Seema Verma, Trump's nominee for CMS administrator, helped develop as a consultant - and a limited Medicaid expansion plan from Utah. The new administration could also develop a template for states that makes clear what changes it is interested in approving through waivers, and the types of reforms it wants to encourage.
"Empower the states. Less red tape. Cut the red tape," Kentucky Gov. Matt Bevin, pointing to a lapel pin with red scissors, said Thursday after meeting with House Energy and Commerce Republicans.
One other thing to note: After the Supreme Court decided that Medicaid expansion under Obamacare was optional, the Obama administration stated in guidance that states still had to expand eligibility up to 138 percent of the federal poverty level to get the ACA's federal funding boost. But Trump's HHS could easily try to change that (perhaps to the federal poverty line), particularly since a growing group of Republican governors are calling for that revision.